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CME

Red Meat May Be Linked to Pancreatic Cancer

  • Authors: News Author: Laurie Barclay, MD
    CME Author: Charles Vega, MD, FAAFP
  • CME Released: 10/10/2005
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 10/10/2006
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Target Audience and Goal Statement

This article is intended for primary care physicians, gastroenterologists, oncologists, and other specialists who care for patients at risk for pancreatic cancer.

The goal of this activity is to provide the latest medical news to physicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Describe risk factors for pancreatic cancer.
  • Identify dietary risk factors for pancreatic cancer.


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Author(s)

  • Laurie Barclay, MD

    Laurie Barclay, MD is a freelance reviewer and writer for Medscape.

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Reviewer(s)

  • Gary Vogin, MD

    Senior Medical Editor, Medscape

    Disclosures

    Disclosure: Gary Vogin, MD, has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P Vega, MD

    Associate Professor, Residency Director, Department of Family Medicine, University of California, Irvine

    Disclosures

    Disclosure: Charles Vega, MD, FAAFP, has disclosed that he has received grants for educational activities from Pfizer.


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CME

Red Meat May Be Linked to Pancreatic Cancer

Authors: News Author: Laurie Barclay, MD CME Author: Charles Vega, MD, FAAFPFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 10/10/2005

Valid for credit through: 10/10/2006

processing....

Oct. 10, 2005 — Red meat, but not poultry, fish, or dairy consumption, is associated with an increased risk of developing pancreatic cancer, according to the results of a prospective study published in the Oct. 5 issue of the Journal of the National Cancer Institute.

"Meat intake has been associated with risk of exocrine pancreatic cancer, but previous findings have been inconsistent," write Ute Nöthlings, MD, from the Cancer Research Center of Hawaii in Honolulu, and colleagues from the Multiethnic Cohort Study. "This association has been attributed to both the fat and cholesterol content of meats and to food preparation methods."

Investigators in the Multiethnic Cohort Study followed up 190,545 individuals for seven years, and they assessed dietary intake using a quantitative food frequency questionnaire. During follow-up, there were 482 incident pancreatic cancers. Cox proportional hazards models were used to determine associations between pancreatic cancer and foods and nutrients relative to total energy intake, stratified by sex and time on study and adjusted for age, smoking status, history of diabetes mellitus and familial pancreatic cancer, ethnicity, and energy intake.

Compared with subjects in the lowest quintile of daily intake of processed meat (g/1,000 kcal), those in the highest quintile had a 68% increased risk (relative risk, 1.68; 95% confidence interval, 1.35 - 2.07; P <.01 for trend). Age-adjusted yearly incidence rates for the respective quintiles were 41.3 and 20.2 per 100,000 persons.

Comparing the highest with the lowest quintiles, intakes of pork and of total red meat were each associated with 50% increases in risk (both P <.01 for trend). Intake of poultry, fish, dairy products, eggs, total fat, saturated fat, and cholesterol were not associated with pancreatic cancer risk. Although intake of total and saturated fat from meat was associated with statistically significant increases in pancreatic cancer risk, intake of total and saturated fat from dairy products was not.

"Red and processed meat intakes were associated with an increased risk of pancreatic cancer," the authors write. "Fat and saturated fat are not likely to contribute to the underlying carcinogenic mechanism because the findings for fat from meat and dairy products differed. Carcinogenic substances related to meat preparation methods might be responsible for the positive association."

Study limitations include population restricted to Hawaii and California, errors inherent in the use of frequency questionnaires, use of nutrient densities in the analyses, incomplete efforts to correct for nutrient measurement errors, possible food measurement error, and adjustment of the analyses for diabetes mellitus as a confounding factor.

"Our findings suggest that intakes of red meat and processed meat are positively associated with pancreatic cancer risk and thus are potential target factors for disease prevention," the authors conclude. "The results raise the possibility that individuals might reduce their risk of pancreatic cancer by reducing consumption of red and processed meat.... Future analyses of meat and pancreatic cancer risk should focus on meat preparation methods and related carcinogens."

The National Cancer Institute, U.S. Department of Health and Human Services, supported this study.

J Natl Cancer Inst. 2005;47:1458-1465

Clinical Context

While pancreatic cancer is not one of the most common cancers encountered by clinicians, it is one of the most deadly. According to the authors of the current study, pancreatic cancer ranks fourth in the U.S. in terms of total deaths caused by cancer, and the five-year survival rate is less than 5%. Known risk factors for pancreatic cancer include male sex, older age, family history, diabetes mellitus, and Native Hawaiian or African-American race. However, the authors note that cigarette smoking is the single biggest risk factor for pancreatic cancer.

Foods higher in fat content have been implicated in promoting pancreatic cancer in some research, although the association may be considered tenuous because of inconsistent data. The authors of the current study report on the seven-year results of a prospective cohort study investigating the relationship between diet and disease outcomes.

Study Highlights

  • Study subjects were participating in the Multiethnic Study Cohort, a group of 215,000 men and women between the ages of 45 to 75 years old who are being followed up for multiple health outcomes. Subjects who were not African American, Latino, Japanese-American, Native Hawaiian, or Caucasian were excluded from the present study, as were those who reported extreme fat, protein, or carbohydrate intakes.
  • All subjects completed a detailed survey on dietary and other health habits at the study outset. Dietary data were broken down into consumption of food groups, and both the frequency and the amount of each food group ingested were recorded.
  • The main study outcome was the incidence of exocrine pancreatic cancer during a 7-year follow-up period. These cancers were recorded based on data from 3 cancer registries. In their statistical analysis, the researchers adjusted the cancer risk of diet for other possible confounders.
  • 190,545 participants had data available for analysis. 45% of the cohort was men, and 25% of the group was Caucasian.
  • For 7 years of follow-up, 482 subjects developed exocrine pancreatic cancer. The mean ages of the cancer vs cancer-free group were 65 and 60 years, respectively, and the respective rates of current smoking were 21.6% and 16%. A family history of pancreatic cancer and diabetes mellitus were also more common in the group with cancer, and African Americans, Japanese Americans, and Native Hawaiians were more likely than the other ethnic groups represented to develop cancer.
  • Higher intake of meat was associated with an increased risk of pancreatic cancer, whereas consumption of fish, poultry, dairy products, and eggs did not increase the cancer risk. The top quintile of intake of processed meat (median daily intake, 18 g/1,000 kcal) had a rate of pancreatic cancer 70% greater than the lowest quintile (median daily intake, 2 g/1,000 kcal). Meanwhile, comparing the lowest and highest quintiles of consumption of pork, beef, and lamb increased the risk of pancreatic cancer by 50%.
  • The median intake of fat was 63 g per day, which translated into a median of 30% of the calories per day from fat. The total amount of fat consumed did not correlate with the risk of pancreatic cancer nor did the amount of fat from dairy products. Similarly, the authors found no relationship between the percentage of energy from saturated fat and the risk of cancer. However, saturated fat intake from meat was associated with a 50% increased risk of pancreatic cancer when comparing the lowest quintile of consumption to the highest quintile.
  • Total cholesterol intake did not correlate with the risk of pancreatic cancer. While nitrosamine consumption demonstrated a positive trend toward an increased risk of cancer, this was not significant. Smoking did not seem to affect the risk of pancreatic cancer as it related to diet history.

Pearls for Practice

  • Cigarette smoking appears to be the most significant risk factor for pancreatic cancer, although other risk factors, such as male sex, older age, family history, diabetes mellitus, and Native Hawaiian or African-American race have been elucidated.
  • Consumption of red and processed meat is associated with an increased risk of exocrine pancreatic cancer, but intake of dairy products is not. The total intake of fat, saturated fat, or cholesterol is also not associated with the risk of pancreatic cancer.

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